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Johns Hopkins Advantage MD Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Johns Hopkins Advantage MD Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Johns Hopkins Advantage MD Select (HMO) in 2025, please refer to our full plan details page.
Johns Hopkins Advantage MD Select (HMO) is a HMO plan offered by Johns Hopkins Healthcare LLC available for enrollment in 2025 to people living in Arlington county, Fairfax City, Falls Church City. The overall rating for this plan is not yet available for 2025.
It's important to know that Johns Hopkins Advantage MD Select (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Johns Hopkins Advantage MD Select (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Johns Hopkins Advantage MD Select (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Johns Hopkins Advantage MD Select (HMO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you can expect to pay a $10 copay for preferred generic drugs at a standard or mail-order pharmacy. Standard generic drugs, preferred brand drugs, and non-preferred drugs have a 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Johns Hopkins Advantage MD Select (HMO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with copays, and ambulance services with a $300 copay. Primary care and preventive services, such as an annual physical exam, are covered with no copay, and the plan also includes coverage for hearing and vision services, such as routine hearing exams and eye exams. Dental services are covered with some services requiring prior authorization, and the plan also provides coverage for home infusion bundled services, dialysis services, medical equipment, and home health services. Additional benefits include coverage for emergency services, cardiac rehabilitation, and skilled nursing facility stays. There is also coverage for diagnostic and radiological services, along with other services like an over-the-counter (OTC) allowance and a meal benefit for chronic illness. The plan also offers coverage for transportation to health-related locations and mental health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $350 copay for days 1-5 and no copay for days 6-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute and Psychiatric, and Non-Medicare-covered stays for Inpatient Hospital-Acute and Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $325 copay, Observation Services with a $325 copay, Ambulatory Surgical Center (ASC) Services with a $280 copay, Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions, and Outpatient Blood Services. Prior authorization is required for Outpatient Hospital Services and Ambulatory Surgical Center (ASC) Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Johns Hopkins Advantage MD Select (HMO) plan, but requires prior authorization. There is no information about the cost of the service, so this information is unavailable.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Johns Hopkins Advantage MD Select (HMO), including ground and air ambulance services, each with a $300 copay. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Johns Hopkins Advantage MD Select (HMO) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage has a $110 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Johns Hopkins Advantage MD Select (HMO) plan covers Primary Care services, including Primary Care Physician Services, with no copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $30 copay and no coinsurance. Physician Specialist Services have a $40 copay, and a doctor referral is required. Mental Health Specialty Services have a $20 copay for individual and group sessions. Podiatry Services have a $50 copay for routine foot care and 20% coinsurance for Medicare-covered services. Other Health Care Professional services have a copay between $0 and $40. Psychiatric Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits are covered for several services. Opioid Treatment Program Services are also covered.
Preventive Services See details
The Johns Hopkins Advantage MD Select (HMO) plan covers preventive services, including an annual physical exam, with no copay. This plan also covers Fitness Benefit and Remote Access Technologies. Other services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams, and fitting/evaluation for hearing aids, with no deductible. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids are covered with a copay between $399 and $699, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$50, and also include coverage for eyewear with a combined maximum benefit of $400 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments. Orthodontic services have a maximum benefit of $1500 per year, but orthodontics itself is not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered, but require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Johns Hopkins Advantage MD Select (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts, each with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Johns Hopkins Advantage MD Select (HMO) requires authorization for some of these benefits.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with at most 20% coinsurance, and outpatient X-ray services with a $20 copay. Lab services are not covered, and diagnostic radiological services have a copay of at most $250. Therapeutic radiological services have at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Johns Hopkins Advantage MD Select (HMO), with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is no copay or coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Johns Hopkins Advantage MD Select (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services include Over-the-Counter (OTC) items, with a maximum benefit of $150 every three months, and a Meal Benefit for chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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